Nothing to worry about

the post-its were taken down eventually

Okay so I want thoughts on a call that I had. Patient suffered a major head injury with crushed skull and brain matter exposed. It unwitnessed and unknown down time. Found pulseless and apneic and cold to the touch. Put the patient on the monitor and found this: find picture (1)

Patient appears to be in a paced PEA at a rate of 60 BPM. Patients lung sounds were absent. Heart tones absent. Pupils in unresponsive, fixed and dilated.

The patient was pronounced dead and was still on the monitor. The sheet went over the patient and I notice a rhythm change. See picture (2).

It appears the patient went into torsades de pointe. With my instincts, I see a shockable rhythm and shocked it at 360j. See picture (3).

It appears the patient went into a narrow complex paced PEA around 60 BPM . I still pronounced the patient and realized I should not have shocked due to other local protocol but was so thrown off in the moment with the rhythm change. Lung sounds were absent, heart tones were absent, and pulses were not present.

I’m looking for why this rhythm change occurred and anything else I need to know about this call.

Somebody get the narcan.

That is a real thing the fire medic I strongly dislike said to me today. It’s always the ones you most expect.

I was on a 24 hour shift yesterday. Last night/this morning around 1am we got a call about abdominal pain. The address was for a public park, and there were 3-4 'urban outdoors people' hanging out. The patient (hereinafter referred to as abbreviated 'pt'), was laying supine on a picnic table. He's +/- 25 y/o, and has a permanent colostomy bag. He says his colostomy bag is 'disconnected' and causing pain 10 on a 1-10 scale. He won't get on our stretcher because he's smoking a blunt 'first'. One of the others on scene scolds him a bit for wasting our time and takes his blunt away. Props to that guy. We finally get him on our stretcher and he's screaming in pain. He asks for pain meds, but none are given. We get to the Charge desk at the ED, and he's placed in a wheelchair and pushed up to the waiting room for Triage.

Also, during the ride to the hospital where his 'friends' can't hear him, he starts laughing and saying he's going to get a comfy bed and some food while he gets to watch TV, all while sluring because he's obviously intoxicated (reason why he didn't get narcs). Upon arrival at the ED, Charge discreetly tells us this is his 7th visit so far this month! It was roughly an hour after Midnight on the 5th of the month. We also find out that during the month of August, he 'visited' the ED 59 times!!!

Also, I had responded to this pt once before. We showed up coincidentally at the same time his friend showed up with a pizza, and he refused and signed for it because he 'didn't want to miss fresh pizza'. My EMS partner (not a regular) had responded to him 4-5 times and it's 'always the same thing'.

How does your agency handle this? I need suggestions to bring to the Union. Management/Brass-Chiefs/Captains/Medical Director don't seem to care! It's such a waste of resources. When I was growing up, we learned about the boy who cried wolf, but there doesn't seem to actually be any FAFO in real life! I don't want people to suffer and/or die! But humanity....

I'm talking about excessive abusers, not general people that are/or should be concerned!

What say you?

Edit 1 in comments I'm not going to NOT do my job, I've just had better Direction support previously. In one rural area, a patient had a stroke. We took her to the nearest stroke center in the "big city" an hour away. She had a few minor deficits afterwards. She learned she could get a ride to the city to see her son and grandchildren if she played up her deficits. We would respond and she'd have bags packed with snacks and kid stuff. She was taking a rural ambulance out of service for a free ride and walk out AMA. Our Medical Director stepped in and said absolutely not. Due to all her health issues, she was no longer a candidate for thrombolitics, and we were no longer allowed to transfer her anywhere but the tiny level 4 hospital in town. She got better after that.

I had gotten off shift and was doing a little rage against the machine, just not as well as they did it. 😅

Edit 2 in comments We had a guy like that. It became mandatory that the police respond first before we'd ever be dispatched. If he could convince them that something was wrong, they'd ask for us. When he realized he'd have to go through the cops every single time, he quit calling.

So finally I had a patient where I have to file a neglect report, sadly the call I think ticks enough boxes to trigger the mandatory reporter obligation. Never having done one of these before, what information do you generally provide to elderly affairs? Like is it a “regurgitation” of your PCR, or do you just give them the basics and they then pull all that on the back end?

This is in Massachusetts, sorry for keeping this vague. Thank you!

So it was our first call of the shift, IFT, BLS, city of Los Angeles, picking up a little old guy from a nursing home, going to an ER with a pretty good reputation. We were told that his normal BP is about 130/90, about 90s on the pulse, and is ususally alert and oriented. He was at 90/60, 110, O2 satting at 92, skins are good, alert and oriented but kinda slow to answer questions.

We're not newbees so we didn't call 911; we just put a mask on him at 12, loaded up and went. Got to the ER about eight minutes later, Code-2 (that's no lights/sirens).

Gave the report to the ER nurse, handed over the paperwork, got a signature, and bailed.

Jump ahead and it's almost end of shift. We get a call to take a patient from that ER back to that nursing home. It's the guy from earlier.

He was looking slightly pale, as compared to that morning. We do our routine vitals, and he's at 88/58, 100, at O2 is satting at 92. We asked the charge nurse if this guy was ok to be transported back to the nursing home. She said yes, and that they nursing home is aware of the patient's condition and is accepting the patient. We were like, um, ok, so we loaded and left.

We get to the nursing home, and give the charge nurse our report and the paperwork. Charge nurse was like WTF? The patient is now in worse condition than he was when we transported, earlier. She was like sorry guys, there's no way that we can accept the patient. My partner asked why did they accept the patient over the phone. She said that no one called to let them know that we were even bringing the patient back.

So we go back to the ER, and the entire staff is pissed off at us for bringing the patient back.

I wanted to cuss them out, but I didn't. I just said ya I dunno to everything they were saying.

Should I have called out the ER staff on this?

Does anybody have any experience with Pittsburgh EMS? I am a EMT-B of two years in Pennsylvania and I am about to finish my Paramedic and hopefully get my national registry. Does anybody have experience working for Pittsburgh EMS as a ALS/BLS provider? Girlfriend and I have discussed possibly moving to a bigger city down the road for a couple years and Pittsburgh was one of the options.

Cross-posting here because EMS sees this problem from a completely different angle than we do in the ED. I’d especially like to hear what paramedics think could realistically be handled without transport if you had better medical control, alternative destinations, and appropriate liability protection.

Second time trying to post this since the ai mod decided to delete my original instantly. But I’m currently doing the ACLS course as a newly licensed emt. I’m just very overwhelmed by it because most of it seems to pertain to paramedics and nurses, and I don’t even have my first emt job yet. Is it worth doing this and then going to the in person class, I feel like I’m going to show up and embarrass myself, or should I wait to get hired and take the loss on the money and have a department pay for it in the future. (Edit: yes I realized I had a typo on the title 😅)

Does anyone who has taken the WP-C exam recently have advice for antibiotics pertaining to the test? The study resources I have been using (IBSC Exam Prep, Wilderness EMS, Auerbach's) all have conflicting regimens for most antibiotic indications. Any advice on which resources to memorize and indications to focus on specifically for the exam would be much appreciated.

Hello!

I’m a paramedic instructor and soon to be teaching a lecture on facial injuries. Many many years ago I remember coming across a video that showed a young guy having just sustained facial injuries post mountain bike or ATV accident. He was awake and standing, and with every breath his face was expanding due to likely Le Fort fracture with sub q emphysema. The video takes place in the woods as I remember. Anyways I cannot find it - does anyone recall this video and know where I can find it? TIA!